Care Coordination
Care Coordination
Care coordination links children and their families with health care and community supports in an effort to achieve good health.
Coordination services may be available from health care and community-based organizations. These services can address medical, social, developmental, behavioral, financial and educational aspects of health. Coordination may include sharing information with different agencies as well as active connection to health care and community services. Children and families must be at the center of the support.
The Medical Home Initiative collaborates with clinical, local and tribal public health and community organizations across Wisconsin to improve support systems of coordination that promote family-centered practice. We invite you to collaboratively pursue solutions to challenges in systems of coordination that benefit all children and families.
Shared Plan of Care (SPoC) Summary
View highlights from a five year SPoC review.
Shared Plan of Care (SPoC) Full Report
Learn how this tool can support communication, collaboration and comanagement between primary care, subspecialists and community partners.
Advancing Family-Centered Care Coordination
The Medical Home Initiative supports Wisconsin professionals, including Tribal Health Centers, to increase knowledge, skills and practices that improve cross-sector coordination for children and youth with special health care needs.
There are multiple tools available to help with care coordination such as care maps, care notebooks and shared plans of care (see our Family Engagement page).
Care Coordinators Collaborative
The Care Coordinators Collaborative is a quarterly, 45-minute session for learning and is open to everyone. To receive communications about 2025 learning opportunities, sign up below for email updates!
2025 Calls
2024 Calls
- Youth to Adult Health Care Transition
- Cross-Sector Alignment to Improve Food Security
- Home Visiting
Have an idea for a future topic or a question?
Please reach out to Program Manager Anna VerKuilen, MPH.
Clinician & Professional Resources
A Blueprint for Change: Guiding Principles for a System of Services for Children and Youth With Special Health Care Needs and Their Families
Outline of the core principles and strategies to transform the system serving children and youth with special health care needs.
Boston Children’s Hospital Integrated Care Program
Support the provision of family-centered care coordination with this comprehensive program.
National Resource Center for Patient/Family-Centered Medical Home
Provides practices with care coordination tools to start and sustain the medical home transformation process.
Shared Plan of Care (SPoC) Example
View an example of a Shared Plan of Care from Indiana University’s Riley Children’s Hospital.
Family Resources
C.A.R.E. Medical Home Series for Families
Learn strategies to coordinate and strengthen communication between your child’s health care team and other partners you work with.
National Resource Center for Patient/Family-Centered Medical Home
Find tools and resources to help coordinate your child’s care.
Pediatric Care Plan Template
See an example of a shared plan of care from University of Kansas. Talk to your provider about developing a plan for your child.
Contact Our Staff
Geeta Wadhwani, MPH, RN, BSN
Program Leader
Medical Home
(414) 337-2231
gwadhwani@childrenswi.org
Anna VerKuilen, MPH
Program Manager
Medical Home
(414) 337-5892
averkuilen@childrenswi.org
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Medical Home Minute
Monthly news, events and resources from the Wisconsin Medical Home Initiative.
The Wisconsin Medical Home Initiative is funded by the Wisconsin Department of Health Services’ Title V Children and Youth with Special Health Care Needs Program and the Maternal Child Health Program located in the Division of Public Health.
